Dissociative (Conversion) Disorders

13/12/2013 by admin | Psychiatry

Definition:  is a condition in which patients present with neurological symptoms such as numbnessblindnessparalysis, or fits without a physiological cause. It is thought that these problems arise in response to difficulties in the patient’s life, and conversion is considered a psychiatric disorder in ICD-10 and DSM-4.

*** It is important to note that the symptom or deficit is not intentionally produced or feigned (as in factitious disorder or malingering)… it is a genuine somatic pathology for the pt ***

Classification / type of disease:

Epidemiology:

  • Diagnosis is difficult, therefore incidence hard to assess – although it is thought to be around 10-20/100,000/yr.
  • More commonly seen in women (~x6 times).
  • Peak onset is thought to be mid-30s

Presenting symptoms / signs:  

Conversion disorder can present with any motor or sensory symptom including any of the following:

  • Weakness/paralysis of a limb or the entire body (hysterical paralysis or motor conversion disorders)
  • Impaired vision (hysterical blindness) or impaired hearing
  • Loss/disturbance of sensation
  • Impairment or loss of speech (hysterical aphonia)
  • Psychogenic non-epileptic seizures
  • Fixed dystonia unlike normal dystonia
  • Tremor, myoclonus or other movement disorders
  • Gait problems (Astasia-abasia)
  • Syncope (fainting)

 

Diagnostic investigations:

In diagnosis, it is important to fully rule out neurological disease, feigning/malingering, and to establish a psychological basis. A history of sexual abuse which has been repressed and then reactivated is quite common in conversion illness.

Aetiology:

Transmission:

Treatment:

  1. Explanation
  2. Physiotherapy
  3. Occupational Therapy to maintain autonomy in activities of daily living
  4. Treatment of comorbid depression or anxiety if present
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